Transcript Cleft lip and palate - IMET2000-Pal

Cleft lip and palate
Prepared by
Maha Hmeidan Nahal RN MSN
Cleft lip and palate
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Cleft—An elongated opening or slit in an organ.
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A cleft lip and/or palate is a birth defect (congenital) of the upper part of the
mouth.
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Cleft lip occurs when the lip elements fail to come together during fetal
development, thus creating an opening in the upper lip between the mouth
and nose.
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A cleft lip creates an opening in the upper lip between the mouth and nose
•
Or When the tissues that form the upper lip fail to join up in the middle of
the face, a gap occurs in the lip.
Definition of
Cleft lip and palate
• Usually, a single gap occurs below one or
other nostril (unilateral cleft lip).
• Sometimes there are two gaps in the
upper lip, each below a nostril (bilateral
Cleft lip).
• and a cleft palate occurs when the roof of
the mouth has not joined completely.
Definition of
Cleft lip and palate
• Cleft palate occurs when the right and left
segments of the palate fail to join properly
Infant with a unilateral cleft lip and palate
•Causes:
• During the fifth through ninth weeks of
pregnancy genetic and environmental factors
are most likely to affect lip and palate
development.
• Certain drugs:
• These include: Anti-convulsive drugs;
Benzodiazepines such as diazepam (valium),
• Or the use of high-dose oral corticosteroids
during early pregnancy.
• Loss of folic acid.
What are the complications associated with
cleft lip and cleft palate
• feeding difficulties
Feeding difficulties occur more with cleft palate abnormalities. The
infant may be unable to suck properly because the roof of the mouth
is not formed completely.
A special teat and bottle should be used to allow milk to be delivered
to the back of the throat where it can be swallowed.
• Sometimes, special dental plates can be used to seal the roof of the
mouth to help the baby suckle milk better.
• ear infections and hearing loss
Ear infections are often due to a dysfunction of the tube that
connects the middle ear and the throat. Recurrent infections can
then lead to hearing loss.
What are the complications associated with
cleft lip and cleft palate
• speech and language delay
Due to the opening of the roof of the mouth and the lip,
muscle function may be decreased, which can lead to a
delay in speech or abnormal speech. Referral to a
speech therapist should be discussed with your child's
physician.
• dental problems
As a result of the abnormalities, teeth may not erupt
normally and orthodontic treatment is usually required.
Treatment for cleft lip and cleft palate:
• Specific treatment will be determined by :
• your child's age, overall health, and medical
history
• specific qualities of your child's abnormality
• your child's tolerance for specific medications,
procedures, or therapies
• involvement of other body parts or systems
• your opinion or preference
Surgery
• For most infants with cleft lip alone, the abnormality can be repaired
within the first several months of life (usually when the baby is 10 to
12 pounds). Or is usually performed three months after the baby is
born.
• Surgery to close the gap in the palate is usually done at about six to
18 months old, but before the age of 2. This is a more complicated
surgery and is done when the baby is bigger and better able to
tolerate the surgery.
•
Both operations are done with the baby asleep under general
anesthetics and involve a hospital stay of three to five days.
After the surgery for cleft lip
• child may be irritable ,medications given to help with this.
• child may also have to wear padded restraints on his elbows to
prevent him from rubbing the stitches and surgery site.
• Stitches will either dissolve on their own or will be removed in
approximately five to seven days
• Specific instructions will be given to you regarding how to feed your
child after the surgery. The scar will gradually fade, but it will never
completely disappear.
•
child will have an intravenous catheter (IV) to provide fluids
• child will feel mild pain, which can be relieved with a non-aspirin
pain medication
• It is normal to have swelling, bruising, and blood around these
stitches.
After the surgery for cleft palate
• This surgery is usually more involved and can cause more
discomfort and pain for the child and it can be relieved by a
non-aspirin pain medication. A prescription medication may
also be given for use at home.
• The stitches will dissolve after several days and they do not
have to be taken out by the physician.
• There may be some bloody drainage coming from the nose and
mouth that will lessen over the first day.
• There will be some swelling at the surgery site, which will
diminish substantially in a week.
• Many infants show signs of nasal congestion after surgery
• child may be in the hospital for one to three days, depending
on his conditions.
Other treatments and therapies
• Speech and language therapy may be used to
monitor and develop speech. Orthodontic
treatment (braces, for example) may be used to
ensure that the permanent teeth come through
straight and in the right place.
• Surgical repair of the palate should be
performed generally prior to or by one year
of age (the time at which the child generally is
beginning to speak)
3. Emotional support
• Support is essential both for new parents coming
to terms with their child's special needs,
• Support for the children themselves who may
have to deal with teasing at school and the
difficulty of being different.
• It can help to discuss the problems with people
who have had similar experiences or by having
access to psychological support available from
specialist cleft teams.
. Prevention
• With so little known about the cause of cleft lip and
palate, even less is known about prevention. The most
sensible approach is simply to do everything possible to
ensure a healthy pregnancy, avoiding known dangers
such as alcohol, smoking and drugs.
• It is thought that certain types of drugs may increase the
risk of cleft lip and palate. These include: Anti-convulsive
drugs; Benzodiazepines such as diazepam (valium),
•
• Evidence suggests that the risk of cleft lip and palate is
associated with the use of high-dose oral corticosteroids
during early pregnancy.
Specialist care
• Ideally, children with cleft lip and palate are
treated by a specialist "cleft team" that includes
plastic, maxillofacial and ENT surgeons as well
as speech and language therapists, dentists,
orthodontists, psychologists and specialist
nurses.
• Care and support of the child and the family
should last from birth until the child stops
growing at about age 18 and got oriented to the
problem or adapted with problem and its
management.